Prevalence of ideal cardiovascular health in a Central European community: results from the Kardiovize Brno 2030 Project

Mortality from cardiovascular disease (CVD) in Central and Eastern Europe, particularly from coronary heart disease (CHD) and stroke, is the highest in the world, in spite of favourable global trends in the past few decades.1–3 To prevent CVD, the American Heart Association (AHA) has recommended assessing seven modifiable risk behaviours and factors using the cardiovascular health (CVH) score in a strategic plan to promote and monitor the CVH goals by the year 2020.4 To date, little is known about contemporary CVH in the Central and Central Eastern European regions. In the present study we aimed to describe the prevalence of ideal CVH in an urban population in the city of Brno, Czech Republic. The Kardiovize Brno 2030 project is an ongoing prospective cohort study assessing the prevalence, determinants, outcomes and trends of CVD in the city of Brno in the Czech Republic.5 The study enrolled a random 5-year age interval and sex-stratified 1% sample of the population aged 25–64 years. The baseline study protocol has been described in detail elsewhere.5 Briefly, after signing the informed consent, participants completed a baseline health interview questionnaire that assessed among others things smoking history, medication intake, physical activity using a validated Czech translation of the long version of the international physical activity questionnaire (IPAQ-L),6 and food intake recall in the prior week along with an expanded food frequency questionnaire (FFQ). Subjects underwent a physical examination assessing the average of three blood pressure measurements that were performed with the patient sitting and after adequate rest, using an automated office measurement device (BpTRU, model BPM 200; BpTRU Medical Devices Ltd., Canada). Height and weight were measured using a digital medical scale with meter (SECA 799; SECA, GmbH and Co. KG, Germany), as well as measurements of waist and hip circumference. Laboratory examinations included total, high-density lipoprotein and low-density lipoprotein-cholesterol and glucose that were performed with 12-hour fasting full blood samples using a Modular SWA P800 analyser (Roche, Basel, Switzerland), all assessed in St Anne’s University Hospital by trained research nurses. All baseline examinations were completed in 2014. The CVH metrics were defined based on the proposed original AHA expert panel,4 and included seven metrics: Body mass index (BMI), physical activity, smoking status, healthy diet score, blood pressure, blood glucose and total cholesterol. The criteria for each of the seven metrics are outlined in Table 1. We analysed CVH as a numerical additive score of these seven metrics, and categorised CVH as ideal (five or more metrics), intermediate (three to four metrics) and poor CVH (two or fewer metrics). We report the overall results and stratified by sex. Data are presented as frequencies with percentages and means ± standard deviations (SD). The chi-square and t-tests were used to test for differences among the sexes. Statistical significance was set at the two-tailed alpha level of 0.05. All analyses were completed using JMP, version 13.0 (SAS Institute Inc., Cary, NC, USA). Definition of cardiovascular health metrics. SBP: systolic blood pressure; DBP: diastolic blood pressure. 1 oz represents approximately 28.4 g. Definition of cardiovascular health metrics. SBP: systolic blood pressure; DBP: diastolic blood pressure. 1 oz represents approximately 28.4 g. Of the 2160 individuals enrolled in the study, we included 2074 (96.1%) with complete information on all seven CVH metrics in this analysis. The participants comprised 47.0% of men and the mean ± SD age of the participants was 47.31 ± 11.3 years. Only two subjects (0.09%) had all seven CVH metrics at the ideal level while 395 (19.0%) had at least five CVH metrics. Conversely, 170 subjects (8.1%) had only one of seven metrics at ideal levels. The majority of Brno adults (50.1%) had intermediate CVH, see Figure 1. Men were more likely to have poor CVH than women (38.2% vs. 24.6, P < 0.0001), respectively, and were less likely to have most of the ideal CVH metrics (12.1% vs. 25.0%, P < 0.0001), see Figure 1. Prevalence of ideal cardiovascular health metrics and categories, overall and stratified by sex, among participants of the Kardiovize Brno 2030 project. *Denotes statistical significant differences across sex, p-value < 0.05. In this community-based sample from Central Europe, few adults had ideal CVH, and men were more affected by poor CVH. To the best of the authors’ knowledge, this is the first contemporary report on CVH in Central/Eastern Europe. Interestingly, these results are similar to those reported in western countries,7,8 and underscore the large room for improvement for CVH, considering that all CVH metrics listed are modifiable. There is convincing evidence that improving ideal CVH, as described in the AHA 2020 goal, protects from cardiovascular and all-cause mortality. Our findings show that the most likely metrics to achieve the highest yield in this population are healthy diet, blood pressure and cholesterol control, representing the factors with the lowest rate of ideal CVH levels. Smoking, on the other hand, represents a highly prevalent CVH factor at a poor level, underscoring the importance of smoking cessation campaigns and clinical programmes. We conclude that these results highlight the importance of systematic efforts in cardiovascular prevention at the population and individual levels. Focusing on these risk factors has the potential to reduce the imposed burden of chronic diseases (i.e. dementia, diabetes, coronary artery disease, heart failure, cancer, chronic lung disease, etc.), and will help accelerate the favourable CVD trends seen in the past 30 years in the region.1 The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Program of Sustainability II (MEYS CR) (no. LQ1605), and by the European Regional Development Fund - Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868).